Provider Demographics
NPI:1366005704
Name:SIMI SPINE AND WELLNESS A CHIROPRACTIC CORPORATION OF SHAWN DECLOEDT
Entity Type:Organization
Organization Name:SIMI SPINE AND WELLNESS A CHIROPRACTIC CORPORATION OF SHAWN DECLOEDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:DECLOEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-581-2310
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-1209
Mailing Address - Country:US
Mailing Address - Phone:805-581-2310
Mailing Address - Fax:805-335-2439
Practice Address - Street 1:3655 ALAMO ST STE 201
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2187
Practice Address - Country:US
Practice Address - Phone:805-581-2310
Practice Address - Fax:805-335-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty